ZHealth News

September 2017 Q & A

Question: Limbs AV Fistula Declot & Stenting Failure; TPA and Repeat Stent for Extravasation

AV left forearm graft fistulogram showed extensive thrombus in main draining vein up to the level of the distal third of the humerus. Crossing sheaths placed. Angiojet catheter used to treat arterial and venous anastamosis. It worked for arterial but not venous. Angioplasty of arterial anastomosis, with arterial flow re-established. Stent was placed across venous anastamosis to improve outflow. Patient continued to clot despite administration of 10,000 units of heparin during the procedure. Multiple passes again made with the angiojet. Flow was not re-established.

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Posted in Free Newsletters By Sondra Dunn

November 2016 Q & A

Question: Cutting Angioplasty with Perforation

Under fluoroscopic guidance, the upper arm dialysis access fistula was catheterized and fistulogram was obtained. There was a greater than 50% stenosis within the mid cephalic vein that was dilated with an 8 mm angioplasty balloon and high pressure angioplasty balloon with no effect. The lesion was then dilated with a cutting balloon. Following angioplasty with a cutting balloon there was a leak identified from the cephalic vein. Multiple attempts at balloon tamponade were performed, and these were unsuccessful at controlling the leak. An 8 mm x 6 cm fluency stent graft was then placed across the leak and dilated to 8 mm. Follow-up fistulogram was obtained and showed free flow of contrast through the stent. Cephalic arch and central veins are patent. The arterial anastomosis is widely patent. There is a small pseudoaneurysm in the cephalic vein near the arterial anastomosis.
I am assigning codes 36147 and 37238. Should something be stated about the perforation? If so, how should this be coded?

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Posted in Free Newsletters By Sondra Dunn

October 2016 Q & A

Question: Femoral Stent to Stop Bleeding

A patient had a TAVR procedure and had continued bleeding of the femoral artery, so a femoral artery stent was deployed. What code do I use for this service? I see that the CPT book states, "Codes 37220-37235 are to be used to describe lower extremity endovascular revascularization services performed for occlusive disease," so I know that these codes do not apply since the stent was deployed for hemostasis. Is this a billable service?

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Posted in Free Newsletters By Sondra Dunn

September 2016 Q & A

Question: Brachial Cutdown Not Involving AAA Repair

I have used 34834 for a brachial artery cutdown for AAA repair. Can you please advise on CPT Code for cutdown of brachial artery for repair of SFA aneurysm with a Viabahn Stent?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - April 2016

Apr 25, 2016 2:20:00 PM

April 2016 Q & A

Question: Popliteal Aneurysm

We are looking for a code for popliteal aneurysm (37236?). This is what one of our physicians said: "34900 code is an aneurysm procedure code, and although specifies iliac it is far more reflective of the procedure type and work, including large sheath placement that is involved with popliteal aneurysm repair. In fact the 2 procedures are almost identical except one is done at a more distal location." What code do you suggest we use for popliteal aneurysm and why?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - March 2016

Mar 30, 2016 2:20:00 PM

March 2016 Q & A

Question: Angioplasty or Primary Thrombectomy with No Stenosis Documented

Patient is on Day 2 of lower extremity arterial thrombolysis with EKOS catheter. The patient was placed on the angio table and the catheter was injected showing significant residual heavy clot burden. The physician ballooned the thrombus in the anterior tibial, posterior tibial and peroneal arteries with a 3mm balloon, then used an aspiration catheter in each vessel post ballooning due to loose clot seen within these vessels. There is no physician documentation of any underlying anatomical stenosis in these vessels. Thrombolysis was restarted with the EKOS catheter and sent to the floor for overnight monitoring. On Day 3, the patient is brought back for AngioJet thrombectomy, repeat ballooning of the peroneal along with thrombolytic spray through the AngioJet for 20 min. This is repeated in the posterior tibial artery. Follow-up angiography demonstrates a flow limiting dissection requiring stent placement.

Day 2 was coded as ...

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Posted in Free Newsletters By Sondra Dunn

January 2016 Q & A

Question: 50435 and 50693

I have a doctor that did a left nephrostogram, ureteral stent insertion and a nephrostomy tube exchange at the same setting. With the new 2016 codes, there is no scenario with a pre existing nephrostomy tract tube exchange and a placement of ureteral stent. I am getting a CCI edit for 50435 saying it shouldn't be billed with 50693. Am I missing something, or misinterpreting something? Would you bill 50693, 50435-XU? Payer is Medicare.
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Posted in Free Newsletters By Sondra Dunn

December 2015 Q & A

Question: WPS and Popliteal Aneurysm

With the new LCD for ICD-10, popliteal aneurysm I72.4 is not covered for 37236. It also is not covered for 37226. What do you recommend if a patient has a popliteal aneurysm and is MCR or MCR replacement in our area? The particular patient I have now is having thrombosis due to the aneurysm, but by coding guidelines it would be covered for intent, which is the aneurysm. The thrombosis is covered under 37226 if it is okay to code for thrombosis and not aneurysm. We do these all the time, this is just the first one that came up since ICD-10 and I need to be able to educate my physicians on coverage.
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Posted in Free Newsletters By Sondra Dunn

October 2014 Q & A

Question: Venous Stent Placement During Thrombolytic Therapy

In the 2014 Interventional Radiology Coding Reference, page 196 example #2, there is a thrombolytic therapy procedure that ends with a venous stent placement. The venous stenting codes do not include the catheter placement, and according to the CPT manual, you should report those in addition to the stents (37238-37229). The example only has the 37238 and does not list a catheter placement CPT code. The thrombolytic catheter is removed and a new catheter for the stent placement is inserted. Other coding references have stated that if a new catheter is placed even from the same access, you would report the catheter placement for the intervention. Wouldn’t you report the venous catheter placement in this example? And if so, what code would you use?

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Posted in Free Newsletters By Sondra Dunn

September 2014 Q & A

Question: Vertebral Artery Stenting

Rt. vertebral artery origin has severe flow-limiting stenosis at level of C-6 and intracranially 50% and 40%. Procedure codes used are 0075T, 76937 x2, G0269, 36140. Impression: Rt. vertebral artery origin severe stenosis reduced to minimal residual after balloon mounted stent placement. Basilar artery flow is improved with lower blood pressure after the intra-arterial administration of vasodilator and rt. vertebral artery origin stent placement. Lt. superficial femoral artery arterial monitoring catheter placement.

Medicare is denying 0075T for modifier incompatibility. ...

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Posted in Free Newsletters By Sondra Dunn

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